Health-related quality of life and symptoms in individuals with chronic obstructive pulmonary disease

Abstract

The purpose of this research was to test a theoretical model adapted from Jones (1998) of the impact of symptoms on Health-Related Quality of Life (HRQOL) in Chronic Obstructive Pulmonary Disease (COPD). The modified model proposed that breathlessness, physical impairment, diminished psychological well-being, negative outlook, and disability had effects on physical and mental components of HRQOL in COPD. A correlational descriptive design was used for a secondary analysis of data obtained from a longitudinal repeated measures design in COPD (Meek, 1995). The sample consisted of 58 individuals with COPD with moderate to severe impairment (FEV₁ = 40.49%) and a mean age of 70.2 ± 8.28 years. The subjects were tested using spirometry, Visual Analogue Scales, Baseline Dyspnea Index, selected subscales of the Bronchitis-Emphysema Symptom checklist (depression/anxiety), Positive and Negative Affect Scale (negative affect), the Pulmonary Functional Status and Dyspnea Scale (activity component), and Medical Outcome Study Short Form-36. Multiple regression analysis was used to examine the relationships in the model. Results of analysis of data in comparison of the over-identified model and an exploratory (just-identified) model demonstrated that parts of the model were not supported by the data and the exploratory model was able to explain more variance in the data than the overidentified model (W = 8.48, p̱ < .10). In this study, the exploratory (just-identified) model was accepted as the final model accounting for 52% of the variance in impaired physical component of HRQOL (Ṟ² = .52, p̱ < .001) and 58% of the variance in impaired mental component of HRQOL (Ṟ² = .58, p̱ < .001). Disability and physical impairment had direct effects on physical health component of HRQOL. Negative outlook and breathlessness had direct effects on mental health component of HRQOL. Breathlessness demonstrated a greater impact than the model would have proposed. Health providers should assess clients' perception of breathlessness and be aware of how that perception could influence HRQOL. Health care providers should plan interventions for individuals with COPD to decrease breathlessness through participating in educational, rehabilitation, or other programs, designated to decrease breathing effort and associated distress.